Provider Demographics
NPI:1598360380
Name:VEDANTHADESIKACHAR, PARTHASARATHY
Entity Type:Individual
Prefix:
First Name:PARTHASARATHY
Middle Name:
Last Name:VEDANTHADESIKACHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8641 NW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2553
Mailing Address - Country:US
Mailing Address - Phone:305-829-0280
Mailing Address - Fax:305-829-4915
Practice Address - Street 1:8641 NW 186TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2553
Practice Address - Country:US
Practice Address - Phone:305-829-0280
Practice Address - Fax:305-829-4915
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist